What is this Obamacare defender doing, exactly?

Andy Slavitt, the former UnitedHealth Group executive who spent two years as the acting head of the Centers for Medic...

Posted: Feb. 8, 2018 8:02 PM

Updated: Feb. 8, 2018 8:02 PM

Andy Slavitt, the former UnitedHealth Group executive who spent two years as the acting head of the Centers for Medicare and Medicaid Services under President Barack Obama, has some experience with rough launches.

In 2013, Slavitt was part of the team that rescued Healthcare.gov after the online marketplace's bungled rollout. Over the next few years, he took a lead role in steering the Affordable Care Act through a fraught implementation period.

Then, amid the squall of Republican efforts to gut the law in 2017, Slavitt emerged, via his Twitter account, as one of the grassroots liberal opposition's favorite wonks. But with the unveiling this week of his new nonprofit, called the "United States of Care," Slavitt himself has come under fire by activists -- some suspicious of his intentions, others confused or troubled by his tactics.

The bipartisan group's aim, it says on a sleek website littered with sometimes impenetrable banalities, is to consolidate public opinion around policies that would "ensure that every single American has access to quality, affordable health care," no matter his or her station. What precisely that means, or how it should be achieved, is left open to interpretation. Those blank spaces have roiled the progressive left, so often criticized for failing to offer specifics in its own advocacy, as it works to build support for a single-payer, or "Medicare for all," plan.

The prospect of reaching across the aisle, in pursuit of good-faith compromise, has also struck many as out of touch with the moment, especially as Democrats fight with one arm against GOP efforts to undercut Obamacare -- like they did in eliminating the individual mandate late last year -- and the other to chart a path toward expanding coverage and care to millions of the uninsured.

On Wednesday, I discussed with Slavitt the organization's purpose and the brewing controversy over his intentions. (Hours later, he tweeted plans to answer the criticism more formally in the coming days.)

The interview that follows has been edited and condensed.

Krieg: On the United States of Care site, you say -- this is a quote -- "We must change the conversation and create a new narrative that puts health care over politics by redefining the goal in human, not political terms. ..." How would you describe the current narrative?

Slavitt: Our narrative, unfortunately, is limited by what our politicians and our lawmakers are willing to do. And the public doesn't feel particularly well represented by that. They feel like the needs of their families, their concerns, aren't represented and that we don't have politics that represent the need for American families to be able to afford to take their kids to the doctor, to afford their prescriptions, so they're fearful.

If we're going to build a new, positive vision, we need to start with a narrative that is grounded in the realities and desires and goals people have to have a better health care system -- and do it in a way that is sustainable, and not worry that it's going to be tipped over every election cycle.

Krieg: Why not then put this energy and these resources behind some of the movements that are already out there? "Medicare for all" obviously now has traction with Senate Democrats, as do other less comprehensive plans. There are a lot of people already out there trying to create a new narrative, in favor of expanding care. Why not put your influence and, maybe, money behind them?

Slavitt: One of the questions (being asked by critics) is about me personally and, you know, I personally am not changing. I don't expect that my views or my activities personally around making sure that we're fighting to get better health care for more people changes. And I don't expect other people who are affiliated with the organization or part of sponsoring it to change their activities, whether they agree with me or disagree with me.

But we have to do something over the long term in addition to make sure that we're not having this war forever. The question is how do we do that? And there's no guarantees that it'll ever happen. But what is clear to me, and I think a number of other people, is if we don't take down the temperature of the debate, then, the next time we go at doing this, we're still going to be more and more divisive.

So I think there is room for us in the debate to focus on both what needs to happen now and over the next couple years -- which is, as you point out, there are a number of organizations that are well-suited for that and some of which I'm affiliated with and will continue to be affiliated with -- but also for there to be a movement that's a little bit longer term that changes the equation. Think about big changes that have happened in the country, (like) marriage equality. That didn't start the year before laws were changed. That started decades before laws were changed. There needs to be a movement and effort to establish successful change that occurs beyond just the current year.

I think this is an organization that has an opportunity, if done right, to make a difference in the long-term debate even while people are working on these very challenging issues in the near term.

Krieg: To be clear, though, you were speaking to Modern Healthcare about this, and you're quoted as saying, "We believe every single American should have access to basic, affordable care. But we avoid using language like universal coverage that is polarizing. We want to bring people together, and certain words are used by one party or another to create divides." So, asking as directly possible: Do you support or oppose single-payer health care?

Slavitt: Do I personally?

Krieg: Yes.

Slavitt: I would personally love to be in a world where we have, once and for all, given every American health care, and that's certainly one way to do it. So, to that extent, the answer is yes.

Krieg: OK, but how do you feel, not personally now, but as an activist or political actor?

Slavitt: What I believe is that there are a number of ideas, including new ideas, that are going to be necessary to get to where we want to get. I believe that it's going to take a number of years from where we are today, so for someone who believes in single-payer, "Medicare for all," I hope that you can also be for other things that are good for people in the meantime, and that those things might even build the ability to get there.

I also believe that there are lots of approaches, because there's not even one ready bill; it's not like there's a bill that's ready that can do everything because the Medicare program, of course, is designed for seniors. It's not designed for younger people, low-income people, etc. So there's a lot of un-sexy dirty work that has to happen, to make these policies work, to get public support for them. To vet them, to drive them.

So if you look at the three principles of (USoC), they include anything that can get people access to the coverage they need, the care they need, protect them from bankruptcy and do it in a way that can be lasting from an economic and political standpoint. That absolutely includes single-payer and it includes other ideas that are either currently formed or that need to be formed.

Krieg: One of the criticisms of the organization is that this, effectively, is an abandoning of politics. It's saying, "We can't fight and win, we need to come to a truce." Is this giving up on politics?

Slavitt: I'm glad you asked that question because that's the exact wrong interpretation.

Krieg: Why?

Slavitt: Because we need to use the grassroots and the will of the people to change the politics and to use the politics and to translate what people really want and believe into political change. The reality is that right now we don't have the political make-up where people have the incentive to compromise. We have people in a world where their incentive is to get more polarized. So when we say health care over politics is a top priority, it (means) that we want to have an impact on constituents first in making care accessible to all Americans.

When we change the politics, or prevail over the politics, what it will mean to me, I think, to many of us on board, is when you show up every day as a lawmaker, who are you thinking about? Are you thinking about your next campaign or are you thinking about your constituents back home and their needs. As soon as we can flip that equation around, I think we will win.

Krieg: Reading your interviews around the rollout, my impression is that you believe policy backed by one party, or a law that's passed along party lines, is intrinsically, if not bad, then doomed. Is that right?

Slavitt: Well, I'll tell you that what I've lived through for the last number of years is something that I hope the country doesn't have to go through much longer -- where one party pulls on one side of the rope and the other party pulls on the other side of the rope.

I think our aim ought to be to get policies that can pass with over 60% to 70% support if we can, because that reflects, at least by what public polling suggests, the will of the American public. I think we'd like to have our elected representatives vote in ways that support where the public is. Now, it's not that simple and a lot of work needs to be done but laws are more stable when we don't feel like every election we worry that they're going to get overturned. So of course it would be better for everybody if we could answer this question once and for all.

Krieg: Going back to your experience these last few years. Republicans have been very open about their position on all this. They do not like Obamacare. But they also don't, as we've seen, really have a plan to replace it. What would you say to activists who argue, even with Republicans on the board, that you're cloistering yourself, with other elite thinker types, and then setting up to negotiate with yourselves?

Slavitt: I don't think anyone is negotiating anything. The question is whether there are people from diverse views who all believe it's time to change the dialogue and that the politics is getting in the way.

There are a number people whose differences were not brought on board to be reconciled. They are perfectly irreconcilable because their goal is not to strive for agreement or even to support whatever policies are approved. Their goal is to say, these are three principles that we should put over politics and, in so doing, we will allow for a dialogue that will get us all to better answers.

There is purposely nothing that all the people who put their names on the website are going to all agree to -- their interests are more purposely diverse. This isn't a convening body which is aiming to forge a tepid consensus. These are people who know that it's going to be OK to publicly to disagree.

And everything I'm saying to you now, I know there are people on the founder's council who will disagree with that -- and they have said to me, "Andy, you know that I may publicly disagree with you." And those are the terms under which their support happens. They're not going to be people who are going to be involved in watering down the policies to a place where they don't accomplish their principles. The principles are fundamental.